Objective To discuss the mechanism about exercise preconditioning (EP) protected myocardium by means of regulate NLRP3 inflammasome signal pathways on exhausted exercise rats. Methods The male Sprague-Dawley (SD) rats were randomly divided into four groups: normal control group (C group), no EP on exhausted exercise group (EE group), 3dEP + EE group, and 3wEP + EE group, with 12 rats in each group. In C group and EE group, the rats had not done exercise, while EE group took an exhausted swimming exercise with 3% heavy weight on tail at the end of 3 weeks; 3dEP + EE group and 3wEP + EE group exercised according to the standard of swimming for 60 minutes every day (swam 15 minutes, took a rest for 5 minutes, repeated 3 times), 6 days in a week, and were trained for 3 days and 3 weeks respectively, and took an exhausted swimming exercise on the last day. A light microscope and electron microscope were used to observe the myocardial histopathology and ultrastructure change, and enzyme linked immunosorbent assay (ELISA) was used to detect the levels of serum interleukin (IL-1β, IL-18, IL-6), hypersensitive C-reactive protein (hs-CRP), MB isoenzyme of creatine kinase (CK-MB), and brain natriuretic peptide (BNP). The protein expressions of NLRP3 and caspase-1 were detected by Western Blot. The correlations among all the parameters were analyzed by Pearson correlation analysis. Results Under the light microscope and electron microscope, the myocardial fiber morphological structure was normal, neatly, and no interstitial edema, muscle membrane damage or myocardial cell swellen was found in C group. In EE group, heart tissues were stained obviously uneven, a large number of myocardial fibers were fractured and messed, interstitial fibers were hyperplasiaed and edema moderately, much of myocardial cells were edema and necrosis, inflammatory cells were infiltrated, the number of average infiltration inflammatory cells was highest, mitochondria were edema seriously, part of the crest and a small number of membrane were blended together, fuzzy and crest were fractured, sarcomere were disordered; 3dEP + EE group and 3wEP + EE group heart tissues injuries were obviously alleviated, among the three groups, and the best results were in 3wEP + EE group. Compared with C group, the serum contents of IL-1β, IL-18, IL-6, hs-CRP, CK-MB, BNP and heart tissues protein expressions of NLRP3 and caspase-1 in EE group were significantly increased [IL-1β (μg/L): 18.77±1.28 vs. 12.00±1.55, IL-18 (μg/L): 236.79±15.73 vs. 150.74±7.09, IL-6 (μg/L): 59.31±9.17 vs. 34.65±2.89, hs-CRP (mg/L): 469.37±137.73 vs. 107.15±14.22, CK-MB (U/L): 15.57±0.91 vs. 7.40±0.40, BNP (ng/L): 532.08±63.44 vs. 386.96±34.77, NLRP3 protein (gray value): 0.66±0.07 vs. 0.16±0.06, caspase-1 protein (gray value): 0.96±0.08 vs. 0.48±0.06, all P < 0.01]. Compared with EE group, the above indicators in 3dEP + EE group and 3wEP + EE group were remarkably decreased, each index in 3wEP + EE group was lower than that in 3dEP + EE group except BNP [IL-1β (μg/L): 14.26±1.42 vs. 16.57±1.81, IL-18 (μg/L): 168.49±7.05 vs. 191.92±14.16, IL-6 (μg/L): 32.62±3.81 vs. 45.61±6.20, hs-CRP (mg/L): 207.06±41.68 vs. 339.56±89.65, CK-MB (U/L): 9.97±1.08 vs. 13.10±0.78, NLRP3 protein (gray value): 0.33±0.07 vs. 0.48±0.06, caspase-1 protein (gray value): 0.65±0.06 vs. 0.79±0.02, all P < 0.01; BNP (ng/L): 432.53±32.03 vs. 478.46±44.79, P > 0.05]. A positive correlation was shown among IL-1β, IL-18, IL-6, hs-CRP, BNP, CK-MB, NLRP3, and caspase-1 (all P < 0.01). Conclusions EP can reduce inflammatory reaction by regulating the NLRP3 inflammatory signal pathways, and protect the myocardial injury. The protection of the heart by long-term EP is more obvious than that of short-term EP.

Objective To investigate the incidence and clinical characteristics and look for assay or examination indexes or indicators with higher sensitivity and specificity of heart damage induced by exhaustive exercise in order to establish its preliminary clinical classification and diagnostic criteria. Methods In a military region for training staff,the clinical data of 88 soldiers who were admitted to the departments of cardiology in 6 general or central hospitals because of exhaustive exercise from January 2000 to December 2010 were analyzed. The myocardial enzyme, electrocardiogram(ECG),echocardiography and other related examination indexes or indicators were observed,and the changes of symptoms,signs and other relevant assay and examination indexes before and after treatment were recorded. Results Exhaustive exercise could cause the symptoms such as chest tightness,palpitations,chest pain, dizziness,shortness of breath,fatigue,syncope and other symptoms,as well as cardiac auscultation abnormalities. After treatment, aspartate aminotransferase〔AST(U/L):20.34±6.33 vs. 35.43±25.25〕,α-hydroxybutyrate dehydrogenase〔α-HBDH(U/L):130.47±9.04 vs. 168.93±62.69〕,lactate dehydrogenase〔LDH(μmol?s-1?L-1):2.48±0.62 vs. 3.58±1.34〕,creatine kinase〔CK(U/L):125.58±67.56 vs. 556.42±381.89〕,creatine kinase isoenzyme〔CK-MB(U/L):11.20±4.08 vs. 23.09±15.61〕were significantly lower than those before treatment(P<0.05 or P<0.01);cardiac troponin T(cTnT)was detected in 5 patients,its level after treatment was significantly lower than that before treatment(μg/L:0.07±0.05 vs. 1.26±0.78,P<0.05). The ECG abnormalities included primarily sinus bradycardia (16 cases),sinus arrhythmia (13 cases) and premature ventricular contractions (11 cases). Echocardiographic abnormalities appeared in 18 cases,they were chiefly as follows:valvular regurgitation, cardiac dysfunction,cardiac enlargement,etc,among which the most common one was valvular regurgitation(all the refluxes were of small amount). Based on the above clinical manifestations and examination results,the exhaustive cardiac injuries were preliminarily divided into common type(20 cases),arrhythmia type(56 cases),heart failure type(2 cases)and sudden death(10 cases). Conclusions The clinical manifestations of exhaustive heart damage may appear in different types. Abnormal changes of myocardial enzymes,ECG and echocardiography are the strong evidences for the damage. Clinicians should pay attention to its prevention and treatment.

Objective To discuss the distribution of traditional Chinese medicine (TCM) syndromes of patients with congestive heart failure (CHF) commonly seen in clinic based on data mining technology.Methods A multicenter study was conducted. 1 451 in-patients with CHF in 4 grade Ⅲ hospitals from December 2010 to September 2012 were enrolled. The cluster and factor methods were applied to synthetically analyze the data concerning the patients' information of four diagnostic methods in TCM, and the TCM syndromes commonly seen in patients with CHF and the preliminary diagnostic scheme were summarized.Results In these 1 451 cases, there were 43 items having been experienced standardization, including clinical symptoms and manifestations of tongue and pulse, and in the information concerning four diagnosis in TCM, there were 14 items whose incidences > 10%. The incidence of chest distress was the highest 89.18% (1 294 cases), followed by shortness of breath 66.16% (960 cases), and the lowest constipation 12.20% (177 cases). There were 4 commonly seen syndromes of CHF as follows: qi deficiency blood stasis syndrome (the major diagnostic bases: palpitation, shortness of breath, dark and red tongue with white fur, thin pulse; and the minor bases: chest distress and thin fur), yang deficiency water diffusion syndrome (major bases: edema of lower limbs, cough, expectoration, difficult urination, chilly, poor appetite, greasy fur, string pulse; minor bases: body strength weakness), phlegm heat obstructing lung syndrome (major bases: chest pain, cough and dyspnea in semi-reclining position, constipation, light tongue with yellow fur, deep, slippery or rapid pulse; minor bases: dizziness), and qi yin deficiency blood stasis syndrome (major bases: dry mouth, night sweating, frequent urination at night, teeth-marked tongue, purplish tongue, uneven or irregular pulse; minor bases: loose stool, headache, purplish lips, swollen tongue with little fur, moderate or weak pulse). The load intervals of each of the symptoms in CHF qi deficiency blood stasis syndrome were from -0.520 to 0.881, all the absolute values were greater than 0.520, and the common degrees extracted were 64.3% - 83.6%, which meant the 5 common factors could extract the original index information all over the common degree 64.3%. In yang deficiency water diffusion syndrome, the load intervals of each of symptoms were from0.732 to 0.983, all the absolute values were greater than 0.732, and the common degrees extracted were 58.2% - 96.9%; in phlegm heat obstructing lung syndrome, the load intervals of each of symptoms were 0.670 - 0.992, the all absolute values were greater than 0.670, and the common degrees extracted were 52.0% - 98.5%. In qi yin deficiency blood stasis syndrome, the load intervals of each of symptoms were 0.576 - 0.926, all the absolute values were greater than 0.576, and the common degrees extracted were 54.2% - 87.1%.Conclusion By application of data mining technology combined with clinical practice, the common TCM syndromes of patients with CHF can be analyzed objectively and comprehensively.

Objective To investigate the effects of captopril on cardiac function and levels of energy-rich phosphates in pressure overload induced left ventricular hypertrophy rats. Methods One hundred and twenty SD rats were randomly divided into three groups: sham operation group (SH group, n=40),coarctation of abdominal aorta group (CAA group, n=40) and captopril treatment 1 mg· 1001·d-1) group (CAP group, n=40). Left ventricular end-diastolic pressure (LVEDP), left ventricular mass index (LVMI), levels of energy-rich phosphates and morphological changes of the myocardial mitochondria were compared at the 6th and 8th week after operation. Results At 6th week, in CAA group, LVMI and LVEDP were increased and ±dp/dtmax was decreased, while ATP and ADP were decreased and AMP was increased (P<0.01). These changes were much obvious at 8th week (P<0.01). Compared with those of CAA group, the parameters of heart function and energy-rich phosphates (ATP, ADP, AMP, TAN) in CAP group were improved significantly(P<0.01) at the 6th and 8th week. In CAP group, the parameters of heart function and energy-rich phosphates (ADP, AMP, TAN) were much better at 8th week than those at 6th week. The morphological change of mitochondria was less in CAP group than that in CAA group. Conclusion Captopril significantly improves myocardial energy metabolism in pressure overload rats and protects the function of myocardial mitochondria.

Objective To investigate the effects of (?)doxazosin [(?)DOX] and its enantiomers on the myocardial morphology,cell cycle and cell apoptosis in rabbits fed with high fat diet. Methods Male New Zealand white rabbits were fed with high fat diet for 4 weeks. Forty such rabbits with hyperlipemia were then divided into atherogenic diet group (model),model + (-)doxazosin [(-)DOX] group,model + (+)doxazosin [(+)DOX] group and model + (?)DOX group (10 each). Another 10 rabbits were included as normal control group. In those drug-treated groups,1.0mg/kg of doxazosin or its enantiomers were intraperitoneally administered for 9 weeks; rabbits in normal control group and atherogenic diet group were given sterile distilled water. Percentages of myocardial cells in G0/G1 phase and in S phase,proliferation index (PI) and apoptotic rate of myocardial cells were compared among the groups,and the effects of doxazosin and its enantiomers were evaluated. Results Of the animals in atherogenic diet group,the proportion of myocardial cells in G0/G1 phase increased significantly (P0.05). No histomorphological alterations were observed in myocardial cells of the rabbits in normal control group. Pathological changes in myocardial cells were observed in the rabbits of atherogenic diet group,such as vacuolar degeneration,fatty degeneration,focal myocardial necrosis,myocardial fibrosis and focal lymphocyte infiltration. The pathological changes in myocardial cells were significantly ameliorated in the animals in (-)DOX and (?)DOX group,but aggravated in the rabbits of (+)DOX group. Conclusions A long term treatment with (-)DOX in the rabbits may improve the histopathological changes in myocardial cells caused by high fat diet. (-)DOX and (+)DOX may have a optical selective effect.

Objective:To investigate the neuroprotective effects of simvastatin on lipopolysaccharide (LPS)-induced rat model ofParkinson's disease(PD) and the mechanisms involved.Methods:Hemiparkinsonian rat models were induced by stereotaxieal injection ofLPS in the right substantia nigra compacta.After2 weeks of simvastatin treatment, rotational behavior test was performed after the intraperitoneal injection of apomorphine.Expression of tyroxine hydroxylase (TH) and glial fibrillary acidic protein were analyzed through immunohistochemical staining of substantia nigra and striatum, and the level ofTNF-α was evaluated using enzyme-linked immunosorbent assay.Results:Comparing with untreated group, behavioral symptoms of the rats were significantly less in the rats that received simvastatin treatment.TheTH positive cell count in substantia nigra and striatum were significantly increased(P<0.05) andTNF-α expression was significantly decreased(P<0.05) in simvastatin group compared to untreated group.Conclusions:Simvastatin could effectively inhibit the activation of astrocytes, reduceTNF-α expression, and exert anti-inflammatory effects, and thus protect the dopaminergic neurons in substantia nigra and striatum of the rat model ofPD.

Objective To observe the effect of stress on the rapid component of delayed rectifier potassium current (IKr) in rat cardiomyocytes. Methods Forty male SD rats were randomly divided into four groups (10 each): control group (Ctrl), exhaustive group (ES), noise group (WN) and composite group (ES+WN). Stress animal models were prepared as follows: Rats in ES group were undergoing exhaustive swimming as the stress factor, in WN group undergoing white noise and in ES+WN group undergoing exhaustive swimming + white noise as the stress factor. Langendorff device was used to reversely perfuse collagenase for isolating the rat's ventricular myocytes. The effect of stress on IKr current and gating mechanism of single ventricular myocyte was recorded by whole-cell patch clamp technique. Results Compared with the Ctrl group, the tail current density of IKr (IKr,tail) of ventricular myocytes increased significantly in ES group and WN group (P<0.01). The IKr,tail current density of the ventricular myocytes in ES+WN group was significantly higher than that in ES group and WN group (P<0.01), and the effect was voltage dependent. Gating mechanism revealed that the half inactivation voltage of IKr,tail (V1/2,inact) can be shifted to the right in ES group, WN group and ES+WN group when compared with the Ctrl group, and the recovery time constant shortened after inactivation (P<0.01). However, the steady-state activation, fast inactivation constant and voltage dependence of IKr,tail were not statistically significant in ES group, WN group and ES+WN group when compared with the Ctrl group. Conclusion Stress increases the IKr current in rat cardiomyocytes, suggesting it be one of the electrophysiological bases of stress-induced arrhythmia.

Objective To propose SHA.LIN nephrolithometry scoring system for assessing and predicting the stone-free rate of percutaneous nephrolithotomy ( PCNL) and to investigate the clinical value of SHA.LIN scoring system for nephrolithiasis in patients undergoing PCNL .Methods A literature review from 1976 to 2014 was performed to identify clinically relevant and reproducible variables that could affect the outcomes of PCNL. Six reproducible variables available from preoperative noncontrast-enhanced computed tomography were measured , including stone size ( S) , hydronephrosis ( H) , anatomic distribution (A), length of tract(L), indicator of CT(I), number of involved calices(N) and was named as SHA.LIN nephrolithometry scoring system .A retrospective analysis was conducted of clinical data of 116 patients with nephrolithiasis undergoing PCNL from June 2011 to March 2015. The general conditions , preoperative information , stone characteristics and perioperative variables were collected . The correlation of nephrolithometry scores based on SHA.LIN scoring system with stone-free status, operation time, blood loss, length of hospital stay and postoperative complications were analyzed . Receiver operating characteristic ( ROC) curves was drawn to detect sensitivity and specificity of SHA .LIN score in predicting the stone-free rates of PCNL.Results The SHA.LIN score was 9.13 ±2.24 in this cohort.The stone free rate was 75.9%(88/116).Postoperative complications occurred in 32 (27.6%) cases.In those patients with stone
free, the SHA.LIN score was 8.27 ±1.62, significantly lower than that in those patients with residual stones 11.86 ±1.72 ( t =-10.069, P=0.000) .The SHA.LIN score showed significant correlation with the postoperative stone free status, operation time, estimated blood loss (P<0.01).But, it did not correlate with postoperative complications and length of hospital stay (P>0.05).The area under curve of ROC curves for the SHA.LIN scoring system was 0.923 ( 95%CI 0.870 -0.975 ) . Conclusions The SHA.LIN nephrolithometry scoring system can predict postoperative stone-free status of PCNL and can be used for disease related assessment.Further research is required to evaluate its performance in predicting peri-operative variables and postoperative complications .

Objective To observe the heart protective effect of exercise preconditioning (EP) in the acute exhaustion exercise (EE) rats, and explore its action mechanism further. Methods Eighty healthy male Sprague-Dawley (SD) rats were divided into control group (C group), EP group, EE group, and EP+EE group randomly, with 20 rats in each group. The rats in EP and EP+EE groups were trained for 3 weeks according to the daily swimming for 60 minutes (swimming 15 minutes, resting 5 minutes, repeating 3 times) with 6 days each week. The rats in EE and EP+EE groups on the last 1 day after 3 weeks, 3% weight heavy weight was carried once for swimming EE. Two hours after the last EE, abdominal aortic blood and heart was harvested, the levels of serum MB isoenzyme of creatine kinase (CK-MB) and calcitonin gene related peptide (CGRP) were determined by enzyme linked immunosorbent assay (ELISA); the ultrastructure of myocardium was observed by optical microscopy; the levels of myocardial malondialdehyde (MDA) and superoxide dismutase (SOD) were determined by ELISA, the mRNA expression of myocardial CGRP was assayed by reverse transcription-polymerase chain reaction (RT-PCR), and the protein expression of myocardial CGRP was assayed by Western Blot. Results Compared with C group, the levels of serum CK-MB and myocardial MDA were significantly increased, serum CGRP content, myocardial SOD activity, and mRNA and protein expressions of myocardial CGRP were significantly decreased in EE group and EP+EE group. Compared with EE group, the levels of serum CK-MB and myocardial MDA in EP+EE group were decreased [CK-MB (U/L): 13.11±0.77 vs. 15.55±0.90, MDA (μmol/L): 389.57±49.60 vs. 709.08±160.49], the level of serum CGRP, and mRNA and protein expressions of myocardium CGRP were increased [serum CGRP (ng/L): 120.41±9.07 vs. 97.97±9.05, CGRP mRNA (2 -ΔΔCT): 0.45±0.09 vs. 0.14±0.02, CGRP protein (gray value): 0.78±0.08 vs. 0.41±0.04, all P < 0.05], the degree of myocardial injury was obviously alleviated. There was no significant difference in the indexes between the EP group and C group. Conclusion EP has the heart protective effect for the acute EE rats, and the mechanism is closely related to the endogenous protective substance CGRP.

Although medical damage risks really exist, an effective medical risk sharing system is still not available in China right now. By analyzing the status quo of Chinese medical damage risks sharing system, the authors put forward the following suggestions to improve the current system: Upgrading the preventive strategy for medical disputes, establishing multi-level and multi-channel comprehensive medical damage risks sharing system, promoting the effective cooperation between insurance relief systems and mediation system for medical disputes, and constructing highly effective pathways to resolve the medical disputes.
China ; Dissent and Disputes ; Humans ; Insurance, Liability ; Malpractice ; Negotiating ; Risk Sharing, Financial